Constipation + FTPM OME

Question 1

causes of failure to pass meconium

Answer 1

Imperforate anus, meconium ileus, hirschsprungs, bilious emesis(duodenal atresia, annular pancreas, malrotation, intestinal atresia)

Question 2

causes of constipation in newborn

Answer 2

Hirschsprungs, voluntary holding, baby whos mom got opiates or Mg for preeclampsia, electrolyte derangements(hypoglycemia, hypokalemia, hypermagnesemia, hypercalcemia)

Question 3

What is imperforate Anus? whats it part of?

Answer 3

imperforate anus, can be either low = close ot anus or high = away from anus; part of VACTERL

Question 4

tx of imperforate anus

Answer 4

Low/close to anus = dilation or minor sugical procedure

High/away from anus= colostomy with future correction

Question 5

What is VACTERL? How do you f/u?

Answer 5

Vertebral Anomalies = Sacral U/S
Anus Imperforate = cross table baby gram
Cardiac defects = echo
TE fistula = NG tub
Esophageal atresia = NG tube
Renal Anomalies = voiding cystourethral gram(VCUG)
Limb Anomalies = xray

*must look for this before you correct imperforate anus

Question 6

Biggest RF for meconium ileus? cause? sx?

Answer 6

cystic fibrosis, meconium is too thick to be passed due to pancreatic insufficiency. FTPM, bilious vomiting

Question 7

what type of kid would you see meconium ileus in?

Answer 7

one with CF, baby whos mom recieved no prenatal care or testing for CF

Question 8

Tx of meconium ileus

Answer 8

Gastrografin enema = water soluble to break down obstruction and pass; sometimes surgery

Question 9

after you tx meconium ileus what else do you need to do for the baby?

Answer 9

F/U w/sweat test, check ADEK, pan enzymes, pulmonary toliet all to check for CF + tx

Question 10

Hirschsprungs Dz

path? sx?

Answer 10

failure of meissner and auerbach INHIBITORY neurons to migrate to distal colon = distal is always contracted. can present as constipation later in life or as FTPM. Look for Xray showing dilated proximal colon= normal & normal looking distal colon = abnormal.

Question 11

dx hirschsprungs dz?

Answer 11

1. contrast enema shows transition zone followed by bx
2. child presents w/overflow incontinence +/-encopresis & has stool eruption on DRE, anorectal manometry shows INCREASED TONE.

Question 12

tx of hirschsprungs dz?

Answer 12

resect + connect and if severe = colostomy

Question 13

What is FTPM?

Answer 13

failure to pass meconium after 48h

Question 14

What is the most common cause of constipation in kids? tx?

Answer 14

voluntary constipation due to kid holding it in either bc they are embarrassed or bc of pain

tx: disimpaction in OR + education

Question 15

why does voluntary constipation cause diarrhea & encopresis?

Answer 15

kid holds in stool = absorbs water = bc hard. only stool that can get past this rock is soft/liquid = diarrhea + encopresis.

Question 16

what medications given to mom can cause constipation in newborn?

Answer 16

Mg for preeclampsia or Opiates